Importance of anesthesiologists' non-technical skills in the management of a case of life-threatening cardiac tamponade during robot-assisted thoracic surgery.

Deficiency of non-technical skills may increase the number of adverse events in the operating room. Sustained life-threatening hypotension due to intraoperative cardiac tamponade during robot-assisted thoracic surgery is rare, requiring prompt assessment and swift decision-making. A 54-year-old woman was scheduled to undergo robot-assisted thoracic surgery for an anterior mediastinal tumor. During the operation, hemodynamic instability occurred despite the administration of a high dose of vasopressor. Anesthesiologists and thoracic surgeons shared information regarding the situation, and decided to perform echocardiography and call other physicians for assistance. Cardiac tamponade was diagnosed during echocardiography, and an incision was made in the pericardium. The patient recovered from the critical situation and was extubated in the operating room. Particularly in robot-assisted surgery, non-technical skills are indispensable to enable the anesthesiologist to successfully manage critical hemodynamic instability owing to unexplained causes.